Objective Isosorbide-5-mononitrate(ISMN), a long-acting venous dilator,has been shown to decrease portal pressure and used in cirrhotic patients to prevent esophageal variceal bleeding(EVB). We performed a meta-analysis to evaluate ISMN in prevention of EVB. Methods Data from Medline(1968-2003), EMBASE(1986-2003), Cochrane Library(issue 3,2003),CJFD(1994-2003) were searched to retrieve randomized controlled trials comparing ISMN combined with or without other treatments to placebo or other treatments in prevention of EVB.Outcome measure was odds ratio( OR ) of bleeding rate. Mantel-Haeszel method was used in fixed model, while Der Simonian and Laird methods were used in random model. Results Seven trials were identified including prevention of first bleeding and rebleeding. The results of meta-analysis indicated that ISMN had no effect on prevention of EVB[study group vs control group: 88/463 vs 117/465, random model: OR (95% CI ): 0.63(0.37, 1.08 )]. Based on sensitivity analysis compared with control group, ISMN had no effect [43/314 vs 40/314, fixed model: OR :0.63(0.37, 1.08)]on prevention of first bleeding, but had therapeutic efficacy [45/149 vs 77/151, fixed model: OR :0.39 (0.24,0.65)]on prevention of rebleeding. Combination therapy of ISMN and ?-blocker revealed more effective than single therapy with ?-blocker[53/327 vs 74/329, fixed model: OR :0.64(0.42, 0.98)]in prevention of rebleeding [25/80 vs 41/81, fixed model: OR :0.44(0.23, 0.85 )], but had no significant difference in prevention of first bleeding[28/247 vs 33/248, fixed model: 0.84(0.48, 1.44)]. Conclusions ISMN is effective in prevention of esophageal variceal rebleeding. Furthermore , combination with ?-blockers has more therapeutic efficacy in prevention of esophageal variceal rebleeding.

Objective To compare the value of clinical application of the ratio of urine albumin to creatinine (ACR) in the community-dwelled middle-aged and elderly at high-risk for diabetes in screening for albuminuria with casual and morning urine specimens. Methods Totally, 443 middle-aged and elderly people (234 men and 209 women) at high-risk for diabetes, with an average age of (59±8) years, were recruited from Changfeng Community of Shanghai in screening for albuminuria with casual and morning urine specimens collected on the same day, as well as another two morning urine specimens collected at an interval of two weeks, for determination of urine ACR. Albuminuria was defined as ACR equal to or more than 30 mg (albumin)/g (creatinnine) in two or more of the three urine specimens collected. Results Overall prevalence of albuminuria was 6. 3% ( 28/443 ) in the middle-aged and elderly according to diagnostic standard mentioned above, significantly higher in casual urine specimens than in morning urine specimens (14. 9% vs. 5.9%, P <0. 05). Urine ACR of casual urine specimens was significantly higher than that of morning urine (7. 1 mg/g vs. 3. 2 mg/g, P<0. 001 ). There was no significant difference in sensitivity and positive predictive value (PPV) between casual and morning urine specimens in screening for albuminuria (96. 4% vs. 92. 9%, and 99.7% vs. 99. 5%, respectively, P >0. 05). Specificity and negative predictive value (NPV) of casual urine specimens was significantly lower than those of morning urine specimens (90.6% vs. 100.0%, and 40.9% vs. 100.0%, respectively, P<0.05). The optimal cut-off value of ACR by casual urine specimens was 40. 0 mg/g in screening for albuminuria, based on receiver operating characteristic (ROC) curve, with sensitivity of 96. 4%, specificity 95.2%, PPV 57.5% and NPV 99. 8%. The middle-aged and elderly with negative albuminuria in morning urine but positive in casual urine had more risk factors for cardiovascular and chronic kidney diseases than those with negative albuminuria in both morning and casual urine specimens. Conclusions Morning urine specimen is better than casual urine for albuminuria screening in the middle-aged and elderly people with risk factors for diabetes in urban community, but casual urine used in screening for albuminuria is very convenient for collection. It is suggested that urine ACR of 40. 0 mg/g be used as an optimal cut-off value for casual urine in albuminuria screening among them.

Objective To understand the life quality of elderly person in communities, nursing homes and elderly wards, and to find out the related influencing factors for providing references for policy-makers to improve the life quality of the elderly. Methods The senior citizens in 9 communities, 3 villages, 12 nursing homes and 5 elderly wards in Shanghai Minhang District were enrolled by stratified cluster sampling. And the life quality and its influential factors among the inhabitants in communities, nursing homes and elderly wards were compared by adopting Short-Form 36 (SF-36) questionnaire. Results Regarding to the life qualities of senior citizens, community showed that physical functioning was (71. 9 ± 23. 3)scores, role physical was (73. 6 ± 43. 0) scores, bodily pain was (80. 2±20. 3)scores, general health was (53. 2± 19. 1)scores, vitality was (70. 4± 15. 7)scores, social function was ( 83. 8 ± 20. 2) scores, role emotional was ( 81. 1 ± 37. 2 ) scores, mental health was (78. 1 ± 15. 4) scores, weighted average was (74. 1 ± 17. 5) scores. Nursing home showed that physical functioning was (42. 1 ±30. 7) scores, role physical was (57. 9 ±48. 1) scores, bodily pain was (78.0±23.0)scores, general health was (50. 2± 19. 5)scores, vitality was (66. 0± 19. 5)scores, social function was (70. 8 ± 26. 3) scores, role emotional was (66. 8 ± 45. 7) scores, mental health was (73. 6 ± 19. 6) scores, weighted average was (63. 2 ± 21. 0) scores. Elderly ward showed that physical functioning was (20. 4 ± 26. 0) scores, role physical was (36. 1 ± 47. 0) scores, bodily pain was (65. 4±29. 5)scores, general health was (43. 1±17. 1)scores, vitality was (59. 0± 18. 0)scores, social function was (57. 9 ± 25. 3) scores, role emotional was (49. 5 ± 48. 7) scores, mental health was (66. 2 ± 18. 3) scores, weighted average was (49. 7 ±18. 3) scores. The major influential factors on the life quality were gender, education, marriage, profession, age, disease, residence, entertainment, physical exercise for community; Age, disease, residence, entertainment, physical exercise for nursing home; Age, etc for elderly ward. Conclusions The influences of demographic factors on life quality of the senior citizens in communities are more significant than in nursing home and elderly wards. Variations on the degree of satisfaction (in residence, entertainment, health care and transportation) and the situation of physical exercise have made vast difference in the life quality of the senior citizens both in communities and nursing homes.

Objective To explore an optimal cut-off value of waist circumference(WC)for identifying metabolic syndrome(MS)in middle-aged and elder residents in an urban community.Methods Database of 1558 residents aged 40-79 years at high-risk in screening for diabetes from Changfeng community,Putuo District,Shanghai during 2005 to 2007 was used to analyze sensitivity and specificity of varied cut-off values of WC for identifying two or more components of MS in men and women,respectively.Receiver operating characteristics(ROC)curve was used to explore the optimal value.Results Optimal cut-off value of WC was 85.0 cm for men and 80.0 cm for women,respectively,for identifying two or more components of MS bv ROC curve,with sensitivity of 72.3%and 74.9%,and specificity of 50.2%and 62.2%,respectively.Based on that optimal cut-off value of WC and definition of International Diabetes Federation(IOF),prevalence of MS was 38.8%in this population,40.7%in men and 37.8%in women,respectively.Conclusion The optimal cut-off value of WC was 85.0 cm in men and 80.0 cm in women,respectively,for identifying MS in the middle-aged and eldedy in an urban community of Shanghai.

Objective To explore the clinical characteristics, diagnosis and treatment of refractory hypertension caused by renal artery fibromuscular dysplasia (FMD) in children. Method The clinical data of a child with refractory hypertension caused by FMD were retrospectively analyzed. Results A boy, with onset at age of 4 years, had significantly increased blood pressure and decreased serum potassium. His renin and angiotensin levels were significantly elevated. The boy was diagnosed with renovascular hypertension by color Doppler ultrasonography, enhanced thoracoabdominal CT and vascular reconstruction. Oral administration of a variety of antihypertensive drugs is not effective. The child was finally diagnosed of refractory hypertension caused by FMD using renal angiography. The child was not suitable for surgery. After adjusting the antihypertensive drugs, the blood pressure of the child tended to be stable. The boy received continuous follow-up for 8 years. The antihypertensive regimen was adjusted annually and blood pressure fluctuations and target organ damage were dynamically assessed. Conclusion Children with FMD caused renal vascular hypertension may have no specific manifestations in the early stage. The drug treatment is preferred, and surgical treatment may be considered.

OBJECTIVETo assess the effectiveness of an educational intervention program in sexually transmitted disease (STD) and condom-related knowledge and promoting condom use among STD patients.

METHODSSTD clinic patients were randomly assigned to three groups (A, control group; B, video viewing group; group C, video viewing plus education with talk) after administered with baseline questionnaire. Each patient was then scheduled to complete the questionnaire regarding the change of STD knowledge and use of condom in two weeks and 3 months.

RESULTSSix hundred and forty-eight patients entered the study. More than half of the patients were aware of STD-related knowledge. However the rate of condom use was very low. When having intercourse with the casual sexual partners the percentage of condom use was only 20%. Seventeen per cent of the patients knew nothing about how to use condom correctly. Follow up results showed that the education program increased the knowledge about STD to some degree. However the percentage of condom use in the latest sexual intercourse increased greatly both in intervention and control groups, but more in intervention groups (P < 0.05).

CONCLUSIONSTD education should be focused on advocating and correcting condom use.

Adult ; Condoms ; statistics & numerical data ; utilization ; Female ; Health Knowledge, Attitudes, Practice ; Health Promotion ; methods ; statistics & numerical data ; Humans ; Male ; Patient Education as Topic ; methods ; Sexually Transmitted Diseases ; prevention & control ; Videotape Recording

Objective:To study the effect of Shenqi Fuzheng injection combined with interferon-α (IFN-α) on the expression of STAT1 gene in hepatocellular carcinoma cells,and to elucidate its mechanism of IFN-α synergistic effect.Methords:The effect of IFN-α injection alone or combined with Shenqi Fuzheng injection on the proliferation of MHCC97-L cells was detected by MTT assay.IFN-α was detected by Real-time PCR and Western-blot respectively.The expression of STAT1 mRNA and protein in the experimental group,the negative control group (NaCl) and the blank control group were determined,and the effect of Shenqi Fuzheng injection on the transcription and expression of STAT1 was determined.The expression of STAT1 in lentiviral vector MTT assay was used to detect the effect of IFN-α alone or in combination with Shenqi Fuzheng injection on the STAT1 gene silencing cells.The expression of STAT1 was detected by RT-PCR and Western-Blot in MHCC97L cells.Strain,on cell proliferation.Results:Compared with IFN-α alone,Shenqi Fuzheng injection combined with IFN-α enhanced the inhibitory effect of IFN-α on MHCC97-L (P＜0.01) and up-regulated the expression of STAT1mRNA and protein (P＜0.05).Successfully constructed the STAT1 gene silent in the MHCC97-L cell line.There was no significant difference in the inhibition rate of MHCC97-L between Shenqi Fuzheng injection and IFN-α (P＞0.05).Conclusion Shenqi Fuzheng Injection can up-regulate the expression of STAT1 in human hepatocellular carcinoma cell line MHCC97-L,so as to increase the effect of IFN-α.

OBJECTIVETo discuss the key role of various mode of circulation assist in the radical operation of retro-peritoneal malignancy with the inferior vena cava thrombotic involvement.

METHODS>From the June 1999 to the March 2001, 6 patients with retro-peritoneal malignancy with thrombosis involving the inferior vena cava, were completely resected with various mode of circulation assist.

RESULTSAll the patients operated have good outcomes and follow-up (1 - 20 months) except one death 1 month after operation.

CONCLUSIONAccording to the various types of tumor thrombi, individualized and technically feasible circulation assist mode should be utilized to achieve the satisfactory outcomes.

Aged ; Assisted Circulation ; Humans ; Male ; Middle Aged ; Retroperitoneal Neoplasms ; blood supply ; surgery ; Surgical Procedures, Operative ; Vena Cava, Inferior ; surgery

Objective To study the clinical, laboratorial, histopathological, imaging features of two cases of hypothyroid myopathy. Method Clinical manifestations, thyroid function, electromyography, muscle MRI, muscle biopsy and follow-up results were collected, and analyzed with the literature. Result These two patients were middle-age to old age and the onset of disease was insidious. Their common clinical manifestations included subacute progressive weakness in the proximal muscles,myalgia after sports and reduction in tendon reflex.The blood test showed an increase in serum concentration of CK and TSH, and a decrease in FT3 and FT4. The electromyography showed suspicious myogenic damage.Muscle histopathological findings were largely nonspecific,such as type I fiber predominance and type 2 atrophy. The MRI revealed extensive muscular dystrophy and fatty filtration in the posterior group of thighs. Treatment of replacement therapy with L-T4 relieved the myopathic symptoms quickly. Conclusion When a patient presents with a subacute progressive weakness in the proximal muscles, the hypothyroidism should be consideration. Muscle histopathological findings may be nonspecific. The muscle MRI have a value of differential diagnosis and lesion assessment.